Delivering hope: Everyday life at a hepatitis C clinic in Cambodia

Friday, July 28th is World Hepatitis Day, a commemoration I never knew about until I joined MSF’s hepatitis C clinic in Phnom Penh, Cambodia, 9 months ago. Suddenly this day seems critically important for everyone to know about.

Cambodia is a low/middle income country where the new direct-acting anti-viral medicines (DAAs) for hepatitis C treatment are not affordable to the vast majority of the population.

These drugs are also prohibitively expensive elsewhere. In Europe, for example, the pharmaceutical corporation Gilead charges as much as US$59,000 per 12-week treatment (€55,000) for one DAA, sofosbuvir; studies have shown that it costs less than $1 per pill to produce the drug.

DAAs have completely changed the landscape of hepatitis C infection. Patients with hep C used to have to suffer through almost a year of subcutaneous interferon for a scant 50 percent chance of clearing the virus from their bloodstream. Almost every one I ever met endured incapacitating side effects during treatment.

Now DAAs furnish effective hepatitis C treatment using pills instead of injected medicines, with minimal side effects, in less than half the time. When I first heard about DAAs I thought this is going to be one of the most important medical breakthroughs to happen during my career.

Thanks to the MSF Access Campaign—which advocates for increasing access to essential medicines, vaccines, and diagnostic tests for patients in developing countries—we will be providing DAA treatment to hepatitis C patients in Cambodia for free. The opportunity to help deliver DAAs to patients who could not otherwise afford them is a privilege I can’t put into words.

A lot of our patients have known they were infected with chronic hepatitis C for a long time, sometimes for decades. They may have assumed there would be no chance of cure, and wondered how many years of their lives would be cut short by the disease. This is why it’s a happy job to work at MSF’s hepatitis C clinic. We give out a lot of good news and we deliver hope.

Although many people have a long knowledge of their own infection, they often don’t know much about the basics of hepatitis C. So a big part of our job is to fill in knowledge gaps as the patients come for screening and treatment.

This is what I tell them.

Hepatitis means inflammation of the liver. There are many causes of hepatitis, including alcohol abuse and the effects of certain medicines, but worldwide, many severe cases of hepatitis are caused by infections. Hepatitis A, B, C, D and E are all caused by viral infections. Despite this, they are all slightly different from each other, and that is why the approach to treatment and prevention is different for each type.

Hepatitis C is transmitted from blood exposure. People who are exposed to blood via high-risk sexual practices, unsafe healthcare procedures, healthcare employment, or childbirth are at risk of getting infected. In Cambodia, we estimate that most of our patients were infected during many years of civil unrest, when the healthcare system collapsed. This is an example of the kind of long-term health consequences that happens during periods of sociopolitical insecurity.

In general, when people get infected with hepatitis C, they have few symptoms. Some people may experience a viral-like illness, but this is actually unusual. Although some people will resolve the infection without treatment, more than half will progress to chronic infection. This is important to understand, because hepatitis C causes most of its damage over years and decades following infection, and it does so almost silently.

Most people with chronic hepatitis C are diagnosed during risk-factor based screening, or because they have abnormal liver enzymes on routine blood tests, and not because they feel sick. During chronic infection, people feel perfectly fine, despite the fact that the hepatitis creates an inflammatory environment that promotes fibrosis, or scarring, of the liver. Some people will only develop mild fibrosis, and are unlikely to progress to the most severe complications of hepatitis C. Unfortunately, a subset of people will develop severe fibrosis, and these are the people who will develop the dreaded complications of hepatitis C: cirrhosis and hepatocellular carcinoma (liver cancer).

Since our clinic opened last October: more than 10,500 people screened for hepatitis C, more than 4,400 diagnosed, and 1,524 people started on treatment. That’s a HUGE number of patients to have seen in the tiny clinic space we have. It’s a real testament to the hard work of our national staff. Every member of staff believes in what we’re doing, and they all agree that the patient comes first.

I am very proud of our team, every day we walk through a crowd of anxious patients to get to the clinic, and every day we confront apparently insurmountable obstacles, and yet every day we are getting people treated for hepatitis C. World Hepatitis Day is an opportunity to remember all those affected by the condition and to promote campaigns such as MSF Access that seek to make life changing treatment affordable.